Permit CITY OF TIGARD ELECTRICAL PERMIT
'11111 * ; COMMUNITY DEVELOPME Permit #: ELC2011 00145
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/22/2011
Parcel: 2S113AC00101
Jurisdiction: Tigard
Site address: 16655 SW 72ND AVE 400
Project: Micro Interconnects Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project Description: (20) branch circuits for TI
Contractor: JOHANSEN ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES
10948 SE VALLEY VIEW TERR 15350 SW SEQUOIA PKWY #300
HAPPY VALLEY, OR 97086 PORTLAND, OR 97224
PHONE: 503 - 698 -3417
PHONE: 503 - 624 -6300
FAX: 503 - 698 -2486
FEES
Quantity Description Date Amount
20 crt Branch Circuits wo /Purchase 03/22/2011 $197.16
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/22/2011 $23.66
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $220.82
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in cordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATT NTION: Oregorh, re 'res you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001- 10 thr ugh OAR 001 -0 90. You may obtain a py of the rules or direct questions to OUNC by cal''' 13. 32.1987 or 1.800.332.23 • .
Issue By: ` "�' Permittee Signa . = ,��
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
ONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date: • =5/0 I
LICENSE NO. 0 .- 3 5
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
,,,,...
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E ect ical Permit Application ' 1 i ) 1 : , 0l IA( 1 t si (r \ 1 .1
City of Tigard
Received 3� �I. _
III Date r8 i Permit No.: t',fC Ap // OD/ 1/5 S
13125 SW Hall Blvd., Tigard, OR 97223 pi. Review
' Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Permit _
1 , I Inspection Line: 503.639,4175 Date Ready/By: runs. il See Page3 for
Internet: www.tigard or. gov Notified/Method: Supplemental Information
_.. Tne 1 a�ui I I l 1 S te t°�:
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As- r t '� ", r ' R : -' �r+awwe�.. �k 1 _I'. o, �t `', tf kiu ,{,i Gt u n 't �:rn r+ IDD 1 e n+ Y f d rf §5 ,,,, o �
14#171 o «. >. ... I _ A.1 1 I , `"' ° 'Y U . ._to 11„ -•1,J , 8 ....1,: k.akt_ s m.. H I u
❑ New construction ® Addition /alteration/replacement Please check all that apply (submit j tots of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over duce stones.
Demolition ❑ ❑ Other, where the available fault current ❑ Marinas and boatyards.
trr(li etnen ij t)ts a l :; fiur*�.�1li rr :eet� # r : ; * t ul W 1 exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
nl hk itabiltWhtsu011a, ∎,. Sid. ii 1/12li g 11V5tI . -A jin. 5' , r � l � ! � 1
_ Ala „ 41
less to grourl& or exceeds 1400 ❑ Conlmeacial -use agrioultm•al
❑ 1- and 2- family dwelling IN Commercial/industrial ❑ Accessory building amps for all other installations buildings.
❑ Multi -family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KV A or
°` tkPr7°:v rlref'k:}� l°r, ip�r r arasm tt T ❑Emergencysystem. larger separately denvedsystem.
F n 2.' ! l •r 7 i s , 4 . "A". "E". ,. l-T , ,: , 1 -3
.. < ..,...1�31Li�raii�xl�i _ .�.. `18tR d:ei. � -_.., r� 1kl va ", ; fhlljgi0 ❑Additionofnewmotaaloadof ❑
Job no,: Job site address: 100HPormare. up�ar.
16 6 5 5 S W 7 2nd ❑Six or more residential units. ❑ Recreational vehicle parka.
City /State/ZIP: ❑ Health-care facilities. ❑ Supply voltage far more than
❑ Hazardous locations. 600 volts manna
Suite/bldg. /apt. no.: 4 0 0 Project name: Micro Interconnect ❑ Servmce or feeder 600 amps or more
�P 11 7i x iIl
')tll6' 1
1 �i �(r* �.;.:3�.utati.lsl! � 0, ' i
Cross streetldirecttons to job site: Description tin. Fee. Teter •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: - Limited energ
a rsk ytr 1 ltd s t g;1 e residential 75.00 2
{�, (1 tf^ r n r `u q ' 7 i�1i (with above sq. ft)
i�sr::t!!li��i. „'° aa„ iu4t IIIVJ n a .�v ..sm o-ml4r' n .4x.... e r
Limited energy, multi- family 75 00 2
Tenant Ira• rovement residential (with above sq. ft.)
Services or feeders installatio alteration, and/or relocation
200 amps or less 100.70 2
i li`; $' 1 ° .:',4r7mtrrrrilwaa 1111
80/1 It 1 , ,'J':• ;;ii.,,,,T14°� t 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Y
Temporary services or feeders installation, alteration, and /or
Oity/State/Z]P:
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
�r m+ vim a (un r „I'I app n t �{ ur „< ., above service or feeder fee i. i t �� 1Ps .aa' r k l t1 f3 r s it aM 7.42 2
;WI i d• , ;4 i , , ,?..1 LL , , ... Cali// III I i S it l r is is . ilitun wii!c....,',., F. sn each branch circuit
Business name: Johansen Electric B. Fee for branch circuits
service or feeder fee, first 1 56.18 56.18 2
Contact name: Charlynn Leifsen branch circuit
Each add'I branch circuit ' 19 7.42 140.982
Address: 10948 SE Valley View Terr Miscellaneous (service or feeder not included)
City/State /ZIP: Happy Valley, OR 9 7 0 8 6 Each manufactured service and/or d/ r feeder 2
ppy y dwelling, service andlor fewer 67.84
Phone: (5 0 3) 698 Fax:: (5 0 3) 698 -2 4 8 6 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail: Sign or outline lighting 67.84 2
}_, 1 . yl ,,,p "u i" aa, I,w�a,m� N I III I lam _
L,a.kr,1 .�(1 }' 1 7 ..,li 1 (: , 'lib's(., u r .:lly (Brill// ellv.�l� >' m r` .r l Signal circuit(s) or limited energy
nusinessname: Johansen Electric
panel, altemion extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 10948 SE Valle View Terr Additional inspection (lhr 66.25/lir
" Investigation (1 hr min) 66.25/ lrr
Ci ty/StatetZlP: Ha • py Valley Valley, OR 9 7 0 8 6 Indnstriel plant (1 hr min) 78.18/ hr
Phone: (503) 698-3417 Fax: (5 0 3) 698-2486 Inspections for which no fee is 90.00/ hr
s,eciftcall listed %.hrmin
eCB Lie.: 515 3 9 Electrical Lie.: 3 - 24 3C Suprv. Lic.: 2 0 5 3 S 1 'ua¢ alt; k p y-T,m ; .fsli : a i ) I 7 ..,:..,.; vsll ? `7 ? '; t i . ': '
Suprv. Electrician signature, required: f k / Suit fee):
19 7.16
Su
P �� q +' ��` / � '� "•�' Plan review (25% of permit fee):
Print name: Carl � ! an s - n a " State surcharge (12% of peanut fee): 3. 3 o.. -•
Authorized signature: lilJ� TOTAL PERMIT FEE: . 33.6-: - 5 1 5 ei ..
This permit application expires if a permit is not obtained within tp .
Print name: Charlynn Leifsen Date: 3/22/11 . days steer it has been accepted es complete,
a Number of inspections allowed per permit.
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